No abstract

No abstract

Burkholderia cepacia is a gram-negative bacillus that is most commonly associated with pneumonia in the immunocompromised patients. The most common organisms associated with pancreatic infections are Escherichia coli , Klebsiella pneumoniae , Enterobacter spp . , and Enterococcus spp. We report a case of a 45-year-old gentleman with recent acute pancreatitis who presented with hypoglycemia, altered mental status, worsening epigastric pain, and early satiety. He was diagnosed with a large peripancreatic infected cyst which grew multidrug-resistant (MDR) Burkholderia cepacia , Candida glabrata , and Candida dubliniensis . This case report focuses on the importance of distinguishing and recognizing risk factors for this MDR organism, in order to provide better patient care.

Background Congestive heart failure (CHF) is a frequent cause of inpatient admissions in the United States. The purpose of this study was to analyze the racial and gender disparities that occur in CHF admissions and determine the impact of these disparities on medical expenditure. Methods We analyzed the National Inpatient Sample (NIS) database from 2009 to 2014 for patients with a primary discharge diagnosis of CHF, and further stratified the cohort on the basis of race and sex. Multivariate analysis was performed to identify the association between CHF and total charges along with other variables such as mortality, length of stay (LOS), and number of procedures. Results There were a total of 5,491,050 admissions with a primary diagnosis of CHF from 977,850 in 2009 to 901,425 in 2014. Females accounted for 49.7%. Total charges for CHF admission were highest in Asians at an average cost of $59,668. African Americans had the lowest mortality rate at 1.75%, however, they also had an average age of admission of 63.47 years, compared to Caucasian at 76.76 (p<0.05). Total charges for males were $42,920 and $36,744 for females (p <0.05). Males also had more procedures at 1.16 vs 0.98 for females (p <0.05). Elixhauser mortality score was higher in males than females at 5.95 vs 5.42 (p <0.05). Conclusion Healthcare disparities exist in CHF admissions in both contexts of race and gender. Further studies are required to pinpoint the source of these differences not only to address mortality but also expenditure costs.

No abstract

Anthracyclines, including doxorubicin, are an important class of chemotherapeutic agents. Their efficacy, however, is limited by cardiotoxicity. Risk factors for anthracycline-associated cardiotoxicity include dose, treatment-specific risk factors including adjunctive radiotherapy, patient-specific modifiable cardiac risk factors including hypertension, hyperlipidemia, diabetes mellitus, tobacco use and obesity, and patient-specific non-modifiable risk factors such as age. The reduction of treatment-specific factors is not always possible, but treatment and reduction of modifiable risk factors should always be an important aspect of the management plan and may reduce the risk of anthracycline-induced cardiotoxicity. We present the case of a 65-year-old male with multiple modifiable cardiovascular risk factors who developed cardiogenic shock shortly after the administration of combination therapy with anthracyclines for the treatment of Hodgkin’s lymphoma.

Hashimoto encephalopathy (HE) is a heterogenous neurological syndrome that can manifest with encephalopathy, seizures, headaches, and variable neuropsychiatric disturbances. The underlying mechanism remains unclear; however, autoimmune pathogenesis is suspected due to its association with autoimmune thyroid disease, high titers of anti-thyroid antibodies, and quick response to steroid therapy. We report a 59-year-old female patient with a remote history of hypothyroidism who presented with status epilepticus and complaints of chronic headaches and cognitive impairment. The presence of sharp frontal waves was identified on her EEG. The patient was initially started on anti-epileptics only; however, her headaches and memory loss escalated, further diagnostic workup was pursued, which revealed high antithyroid peroxidase antibodies with normal thyroid function tests. The only cerebrospinal fluid (CSF) abnormality noticed was an elevated protein concentration. MRI showed non-specific right frontal lobe pial enhancement. Remaining infectious, rheumatologic, and neurologic testing was unremarkable. The patient was started on a steroid regimen with successful resolution of symptoms and return of cognitive baseline. Hashimoto's encephalopathy is a diagnosis of exclusion; however, it should be considered in patients with high titers of anti-thyroid antibodies and neurological symptoms that cannot be explained by thorough infectious, metabolic, and autoimmune testing. It is essential to recognize this neurological entity as fast clinical improvement may be achieved with steroids and other immunotherapies.

No abstract